Citation Nr: 9830389
Decision Date: 10/13/98 Archive Date: 10/21/98
DOCKET NO. 95-34 862 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in New York,
New York
THE ISSUE
Entitlement to service connection for a psychiatric disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
The veteran
ATTORNEY FOR THE BOARD
D. M. Casula, Associate Counsel
INTRODUCTION
The veteran had active military service from December 1960 to
December 1961.
This matter comes before the Board of Veterans’ Appeals
(Board) from a December 1992 rating decision of the New York,
New York Regional Office (RO) of the Department of Veterans
Affairs (VA) which denied service connection for a nervous
condition with claimed depression and headaches.
REMAND
The veteran contends that he has a nervous condition as a
result of his service.
Service medical records show that in April 1961 the veteran
was referred for a psychiatric evaluation. He appeared to
have an emotional disorder that became worse each day and
demonstrated a lack of initiative, forgetfulness, and
immature reasoning. On examination in May 1961 he reported
experiencing anxiety and depression. It was noted that he
possessed a great deal of repressed hostility and had
difficulty accepting close, warm relationships. He had never
been able to concentrate on and complete a task. The
impression was that he could succeed in the Air Force with
counseling. In November 1961 he reported to military sick
call, agitated and claiming that he could not “go on any
longer”. He was admitted to the hospital due to anxiety.
On psychiatric examination he reported he had always been
tense and poorly adjusted. He reported having a hard time
since he entered service. He had antagonistic feelings
toward others and felt hated by other trainees and airmen.
He felt others ridiculed him, and believed his superiors
thought he was crazy. He was unable to sleep, became
agitated and excitable and reacted to noises with feelings of
panic. He had ideas of “unreality” and severe anxiety. He
felt he could not adjust to service and wanted to be
released. He did not display features of neurotic or
psychotic development. He was unable to comply with the
usual social order and when exposed to stress reacted with
ideas of “unreality”. The diagnosis was schizoid
personality, with a predisposition of severe, personality
pattern disturbance from childhood. His impairment was noted
to be moderately severe, but not actively psychotic. In a
November 1961 statement it was noted that the veteran had a
character and behavior disorder, of the type usually termed
schizoid personality. It was improbable that he would make a
satisfactory adjustment to the military, and it was likely
that his emotional disorder would become worse in service.
It was recommended that he be discharged administratively.
On separation examination in December 1961 he reported good
health, except for “nerves”; it was noted that he had a
personality disorder.
In a July 1992 statement, Melvin Shulman, M.D., reported that
he saw the veteran for psychiatric consultation. The veteran
reported having more and more severe headaches, which he
attributed to his growing nervous tension. He indicated that
he became more and more nervous, disorganized, forgetful,
unable to concentrate, and unable to sustain anything for a
long time. He did not have a normal life and adjustment
prior to entering service, and had been subject to
nervousness and headaches all of his life, but they had
become much worse in recent years. Dr. Shulman indicated
that he saw the veteran as having a life-long personality
disorder and suffering from a variety of nervous symptoms.
Passive aggressive personality disorder was diagnosed.
In a November 1994 letter, Jonathan E. Rosenfeld, M.D.,
Ph.D., indicated that he had been treating the veteran since
June 1994, following the illness and institutionalization of
his mother. Adjustment disorder and personality disorder
were diagnosed.
In a February 1995 psychiatric evaluation report, Roland
Foraste, M.D. indicated that he had reviewed the veteran’s
records. Dr. Foraste indicated that the veteran’s discharge
from service was because of schizoid personality, but noted
that he was also bordering on psychosis and was treated with
Thorazine -- leading him to question if the diagnosis was
understated at the time of discharge. Dr. Foraste noted that
the veteran presented a history of a dysfunctional life
before and since service, but aggravated by service and
remaining worse since. Dr. Foraste noted that the veteran
suffered from extreme anxiety, insomnia, and depression. It
was also noted that an evaluation was in process, to focus on
treatment.
It appears that the veteran has submitted only partial
records of his psychiatric treatment, as there are no records
of the reported evaluation and any subsequent treatment by
Roland Foraste, M.D. Reports of such treatment may contain
information vital to the veteran’s claim.
The Board notes that the medical evidence of record shows
that a personality disorder was diagnosed in service and
postservice. A personality disorder is not a compensable
disability. 38 C.F.R. § 3.303(c). However, the record also
reflects that during service the veteran experienced trouble
sleeping, anxiety, headaches, and nervousness, and he has had
similar complaints postservice, which were most recently
confirmed by Dr. Foraste. In the February 1995 report, Dr.
Foraste appears to opine that the veteran has an acquired
psychiatric disorder that may have first been manifested in,
or increased in severity during, service.
The record is not clear regarding the diagnosis of the
veteran’s current psychiatric disability and its relationship
to service. In September 1993 he failed to report for a VA
examination. The duty to assist is not a one-way street.
The veteran must assist in the development of his claim,
including reporting for scheduled VA examinations.
Based on the facts presented, the veteran’s claim is
plausible and, thus, well grounded. Hence, the VA has a duty
to assist the veteran in the development of all facts
pertinent to his claim. 38 U.S.C.A. § 5107(a)(West 1991 &
Supp. 1998). In light of the foregoing, the case is REMANDED
to the RO for the following:
1. The RO should obtain from the veteran
the names and addresses of any additional
medical care providers (VA and private)
who have treated him for any psychiatric
disorder since February 1995. The RO
should obtain copies of all pertinent
records (which are not already in the
file) from the identified treatment
sources. These should specifically
include records from Roland Foraste, M.D.
The veteran should be advised of the
provisions of 38 C.F.R. §§ 3.158, 3.655
in conjunction with the requests in this
remand.
2. The RO should then schedule the
veteran for a VA psychiatric examination
to determine the nature and probable
etiology of any current psychiatric
disorder. The claims file must be
available to (and reviewed by) the
examiner. The examiner should indicate
whether the veteran now has an acquired
psychiatric disorder and, if so, whether
(as likely as not) it is related to any
symptoms exhibited in service (and, if
so, indicate the nature of the
relationship). The examiner should fully
explain the rationale for the opinion.
3. The RO should then readjudicate the
claim, applying 38 C.F.R. § 3.158 or
§ 3.655, as indicated. If it remains
denied, the veteran should be provided an
appropriate supplemental statement of the
case and given opportunity to respond.
Thereafter, the claim should be returned to the Board for
further review. No action is required of the veteran unless
he receives further notice.
This claim must be afforded expeditious treatment by the RO.
The law requires that all claims that are remanded by the
Board of Veterans’ Appeals or by the United States Court of
Veterans Appeals for additional development or other
appropriate action must be handled in an expeditious manner.
See The Veterans’ Benefits Improvements Act of 1994, Pub. L.
No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A.
§ 5101 (West Supp. 1998) (Historical and Statutory Notes).
In addition, VBA’s ADJUDICATION PROCEDURE MANUAL, M21-1, Part
IV, directs the ROs to provide expeditious handling of all
cases that have been
remanded by the Board and the Court. See M21-1, Part IV,
paras. 8.44-8.45 and 38.02-38.03.
GEORGE R. SENYK
Member, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1998), only a
decision of the Board of Veterans' Appeals is appealable to
the United States Court of Veterans Appeals. This remand is
in the nature of a preliminary order and does not constitute
a decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (1998).
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